INVEST Feasibility - Minimally Invasive Endoscopic Surgery With Apollo in Patients With Brain Hemorrhage

Inclusion Criteria: * Patient age ≥ 22 and ≤ 80, or age \< 85 with baseline mRS=0 * Supratentorial ICH of volume ≥ 30 mL \< 80 ml (measured using A x B X C/2 method) * CT/MR demonstrates ICH stability (\< 5 cc growth) at 6 hours after admission scan * If the initial stability scan shows growth, a second stability scan can be performed q12h until stability is demonstrated or until eligibility for the study has lapsed. * NIHSS ≥ 6 * Presenting GCS 5 - 15 * Historical mRS 0 to 2 * Symptom onset \< 24 h prior initial CT * Apollo MIES can be initiated within 72h of ictus/bleed * SBP can be controlled \< 160 mmHg and sustained at this level for at least 6 hours Exclusion Criteria: * Imaging * Expanding hemorrhage on stability CT/MR scan * "Spot sign" identified on CTA (May perform a second CTA at 12 hours to demonstrate resolution) * Hemorrhagic lesion such as a vascular malformation (cavernous malformation, AVM etc), aneurysm, neoplasm * Hemorrhagic conversion of an underlying ischemic stroke * Infratentorial hemorrhage * Large associated intra-ventricular hemorrhage requiring treatment for IVH-related mass effect or shift due to trapped ventricle (EVD for ICP management is allowed) * Midbrain extension/involvement * Absolute contraindication to CTA, conventional angiography, and MRA * Coagulation Issues * Absolute requirement for long-term anti-coagulation (e.g., Mechanical valve replacement (bio-prostatic valve is permitted), high risk atrial fibrillation) * Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency * Platelet count \< 100 x 103 cells/mm3 or known platelet dysfunction * INR \> 1.4, elevated prothrombin time or activated partial thromboplastin time (aPTT), which cannot be corrected or otherwise accounted for (i.e., lupus anti-coagulant) * Patient Factors * Presenting GCS 3 or 4. * High risk condition for ischemic stroke (high risk Afib (e.g., mitral stenosis with Afib), symptomatic carotid stenosis) * Requirement for emergent surgical decompression or uncontrolled ICP after EVD * Unable to obtain consent from patient or appropriate surrogate (for patients without competence) * Pregnancy, breast-feeding, or positive pregnancy test \[either serum or urine\] (Woman of child-bearing potential must have a negative pregnancy test prior to the study procedure.) * Evidence of active infection \[indicated by fever (at or over 100.7 °F) and/or open draining wound\] at the time of randomization * Any comorbid disease or condition expected to compromise survival or ability to complete follow-up assessments through 180 days. * Based on investigator's judgment, patient does not have the necessary mental capacity to participate or is unwilling or unable to comply with protocol follow up appointment schedule. * Active drug or alcohol use or dependence that, in the opinion of the site investigator would interfere with adherence to study requirements. * Currently participating in another interventional (drug, device, etc) research project.